1982, 03-22 Permit: 80-7587 Inspectas �
INSPECTION RECORD
OWNER LOCATION
CONTRACTOR TYPE OF WORK
NSEW
SET BACKS
FINAL INSPECTION:
DATE REMARKS:
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APPLICANT: COMPLETE NUMBERED SPACES- PRESS HARD TO MAKE 3 COPIES
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LEGAL DESCRIPTION -SEE ATTACHED
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t t SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
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DATE
SIGNATURE REnrnrrucaN* Wig' n En
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EPA
PEES COLLECTED
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TOTAL e Vio a
e/33
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'•10[00
•1000061
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09-11'•80
P 6499 •.N